Providing independent recreational activities to reduce stereotypic vocalizations in chronic schizophrenics

The spectrum of involuntary vocalizations in humans: A video atlas

In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The Effectiveness of Supported Employment in People With Dual Disorders

OBJECTIVE: This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder. METHODS: A secondary data analysis was conducted drawing from four randomized controlled trials comparing IPS supported employment to conventional vocational rehabilitation programs for severe mental illness, and focusing on the 106 clients with a recent (past 6 months) substance use disorder. Competitive work outcomes were tracked across an 18-month follow-up period. Analyses compared the IPS and comparison vocational programs on cumulative work over the 18 months, including attainment of work, hours and weeks worked, job tenure, wages earned, and days to first job. RESULTS: In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up. CONCLUSIONS: The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.

The reinforcing effect of contingent attention on verbal perseverations of two children with severe visual impairment

The frequency of verbal perseverations of two children with severe visual impairment was reduced using differential reinforcement of appropriate speech coupled with extinction of perseverative utterances. A reversal design in which baseline and intervention were alternated in an A-B-A-B sequence was employed to show the functional relationship between the target behaviors and the treatment procedure. There was a marked increase in appropriate utterances and a correlated decrease in perseverative ones. These findings suggest that this singular feature of the language of certain children with visual impairment is, under natural conditions, probably maintained by the attention provided by their caregivers.

A controlled study of disruptive vocalizations among geriatric residents in nursing homes

This paper reports the results of a controlled study comparing geriatric residents in nursing homes who displayed disruptive vocalizations with residents in a comparison group. Two 350-bed nursing homes were surveyed, and it was found that 11% of the residents engaged in disruptive vocalizations, at least once per week, of sufficient severity to require consideration in the resident's care plan. Results show that disruptive vocalizers were more functionally impaired and were more likely to receive a diagnosis of dementia. They were also more likely to display a higher activity level and to experience sleep disturbance and to be prescribed neuroleptic medications. Descriptive data are presented on typology of disruptive vocalizations, likely situations for their occurrence, and the utilization and perceived efficacy of common interventions. Suggestions are made regarding behavioral treatments for this vexing problem.

Prescriptive rehabilitation for severely disabled psychiatric patients

Several behavioral rehabilitation strategies have been empirically validated in the treatment of schizophrenia and are now the psychosocial treatments of choice for chronic mental disorders. The stress-vulnerability model and an empirically based decision tree offer clinicians' guidance in prescribing strategies that are particularly relevant for each patient. Hence, behavioral family therapy may be indicated for patients who experience disease exacerbation that results from stressful family interactions. Patients with insufficient social and coping skills may benefit from skills training. Supported employment and job-finding clubs may be indicated for patients with deficits in work skills. The form and programmatic matrix of these strategies differ, depending upon their locus in inpatient and outpatient settings.

Functional analysis and treatment of bizarre speech

Contingencies maintaining the bizarre speech of a 29-year-old woman with mild mental retardation and schizophrenia were analysed. Bizarre vocalizations occurred most frequently during demand conditions and least frequently during one-to-one interaction with attention contingent upon appropriate vocalizations. Treatment conditions derived from the assessment consisted of guided compliance and ignoring plus contingent attention. Treatment effects generalized to direct-care staff in day and residential settings. Analysis of the variables controlling bizarre speech facilitated development of interventions that were predominantly positive in nature, based on the specific and unique controlling behavior-environment interactions, and that were teachable to the direct-care staff.